Treatment process using lifestyle modifications, medication and, in selected cases, surgical options to reduce heartburn and acid regurgitation caused by stomach contents flowing back into the esophagus.
Indication
- Frequently recurring heartburn and regurgitation
- Reflux esophagitis or Barrett's esophagus detected on endoscopy
- Reflux-related chronic cough, hoarseness or asthma-like findings
- Chest pain that increases when lying down (after cardiac causes have been ruled out)
- Chronic dyspepsia that adversely affects quality of life
- GERD developing on a background of hiatal hernia
Preparation
- Duration, frequency and triggers of complaints are reviewed in detail
- If needed, endoscopy assesses esophageal damage and gastric pathology
- In refractory cases 24-hour pH-impedance monitoring may be planned
- Current medications (especially NSAIDs and calcium channel blockers) are reviewed
- Cardiac causes of chest pain are excluded
How it's performed
- Lifestyle advice is given: weight control, head-of-bed elevation, avoiding late meals
- Trigger foods (fatty, spicy, chocolate, caffeine, alcohol, carbonated drinks) are reduced
- First-line medical therapy is a proton pump inhibitor (PPI), generally for 8 weeks
- Once symptoms regress, the lowest effective maintenance dose or on-demand use is planned
- In refractory cases H. pylori screening, alginate or prokinetic drugs are considered
- In selected cases anti-reflux surgery (fundoplication) consultation may be advised
Post-procedure
- Clinical response is assessed at week 4-8 of treatment
- If long-term PPI use is required, dose reduction to the minimum effective level is planned
- In long-standing reflux, endoscopic surveillance for Barrett's esophagus may be advised
- Adherence to lifestyle recommendations is reviewed at every visit
- Patients who underwent surgery are followed for swallowing difficulty and gas-related symptoms
Risks
- Rare headache, diarrhea or low magnesium/B12 with PPIs
- Long-term high-dose PPI use may increase risk of osteoporosis and infection
- Symptom recurrence when treatment is stopped
- After surgery: swallowing difficulty, inability to belch or gas bloating
- Uncontrolled long-standing reflux may lead to esophageal stricture, Barrett's esophagus and rarely esophageal cancer
FAQ
Will I have to take reflux medication for life?
In many patients medication is reduced to a low dose or used on demand after a defined period. The decision depends on disease severity and endoscopic findings.
Which foods worsen reflux?
Fatty and spicy foods, chocolate, caffeine, alcohol, carbonated drinks and large portions can trigger reflux. Personal triggers vary between individuals.
Who is offered surgical treatment?
Surgery (fundoplication) may be an option for patients with persistent symptoms despite adequate medication, those who do not wish to take medication, or those with a large hiatal hernia.
Can reflux be confused with cardiac pain?
Yes. Reflux-related chest pain may resemble cardiac pain; on initial assessment cardiac causes must be ruled out first.
Related Information
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Upper GI endoscopy (gastroscopy) — visualization of the esophagus, stomach, and duodenum.
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